Youth tobacco use in Latin America: What is the real extent of the problem?

INTRODUCTION: Cigarette consumption among teenagers is one of the most critical health-related risk behaviors. METHOD: Prospective study carried out in seven sites of five Latin American countries (Argentina [Cordoba, N=958, Corrientes, N=1013], Brazil [Curitiba, N=650; Uruguaiana, N=997], Cuba [Havana, N=1004], Mexico [Veracruz, N=991] and Paraguay [Ciudad del Este, N=868]) with public-school adolescents (aged 12-19 years). Respondents were asked to answer the California Student Tobacco Survey. RESULTS: 6550 adolescents took part in the survey (average age: 14 years). 38.5% (N=2517) "tried smoking" and 37.5% started smoking before the age of 12. Sixty-one percent of adolescents think that cigarettes are easily accessible; 41.7% considered that smokers have more friends; 88% indicated knowledge of the harms of smoking one to five cigarettes per day; 58.9% would smoke new cigarette types with less harmful substances; 27.8% have already used e-cigarettes; 28% have smoked hookah. Fifty-seven point five percent have been, in the past seven days, in the same room with someone who was smoking a cigarette; and 30.5% indicated that there were not any no-smoking rules inside their homes. Identifiable risk factors were (logistic regression analysis): smoking cigarettes offered by friends, smoking cigarettes with less harmful substances, knowing what a hookah is, being in the same room with a smoker in the past week. Identifiable protective factors against tobacco use were: knowing the health risks caused by smoking hookah and to have their own room. CONCLUSION: Youth tobacco use in Latin America is a major public health concern, and tobacco control measures are highly needed.

Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study.

BACKGROUND: Atopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4-10 years) from nine countries, and in normal controls (C). METHODS: Parents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained. RESULTS: C and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2±16.1 vs 53.3±12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r=-0.02, p=0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p<0.0001), sleep anxiety (0.29, p<0.0001), night awakening (0.36, p<0.0001), parasomnias (0.54, p<0.0001), sleep-disordered breathing (0.42, p<0.0001), daytime sleepiness (0.26, p<0.0001) and total CSHQ (0.46, p<0.0001). AD patients had significantly higher elevated body mass index. CONCLUSION: Latin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.

Sleep disorders in Latin-American children with asthma and/or allergic rhinitis and normal controls.

BACKGROUND: Asthma and/or allergic rhinitis have been associated with sleep disorders. The aim of this study was to evaluate sleep disorders in Latin-American children (4-10 years) from nine countries, with persistent asthma (A) and/or allergic rhinitis (AR) and in normal controls (C). METHODS: Parents from 454 C children and 700 A and/or AR children followed up in allergy reference clinics completed the Children's Sleep Habits Questionnaire (CSHQ) which is a retrospective one-week questionnaire composed of 33 questions composed of seven subscales (bedtime resistance, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing and daytime sleepiness). The total scale of CSHQ and the subscales were compared between groups C and A+AR, A (n=285) vs. AR (n=390), and between controlled A (CA, n=103) vs. partially controlled/uncontrolled A (UA, n=182). RESULTS: The comparison between C and A+AR showed no significant differences in age (6.7 years vs. 7.0 years, respectively), mean Body Mass Index and total scale of CSHQ (53.3 vs. 63.2, respectively) and the subscales were significantly higher in the A+AR group. Comparison between groups A and AR, except for sleep anxiety, showed significantly higher values for CSHQ total scale (66.9 vs. 61.0, respectively) and subscales for group A. The UA group showed significantly higher values for total CSHQ scale and subscales in comparison to CA (71.1 vs. 59.4, respectively). CONCLUSIONS: Latin-American children with asthma and/or allergic rhinitis showed sleep disorders identified by the CSHQ when compared to normal controls. Despite being treated, asthma causes sleep impairment, especially when uncontrolled.

Reconstrucción microquirúrgica en el trauma pediátrico / Microsurgical reconstruction in pediatric trauma

Introduction: We present a series of clinical cases in which free tissue transfer was performed to repair traumatic defects in 4 pediatric patients (5 free flaps). Each clinical case was analyzed for free flap indication, complication and outcome. Case reports: There were a total of 2 musculotaneous flaps (latissimus dorsi and rectus abdominis) and 3 fasciocutaneous flaps (anterolateral thigh). One case required surgical revision and no flap losses are reported. At present patients are in rehabilitation phase after an average of 12 months of follow-up. This series is the first national communication of microsurgical reconstruction in the pediatric trauma patient.

Introducción: Se presenta una serie de casos clínicos en la cual se realiza transferencia libre de tejidos para solucionar defectos de cobertura de origen traumático en 4 pacientes pediátricos (5 colgajos libres). Se analiza cada caso clínico, la indicación de colgajo libre, complicaciones y resultados. Casos clínicos: Se realizaron 2 colgajos musculares (dorsal ancho y recto abdominal) y 3 colgajos fasciocutáneos (anterolateral de muslo). Sólo un caso requirió revisión quirúrgica, no tuvimos pérdidas de colgajos y hasta la fecha los pacientes se encuentran en fase de rehabilitación, tras un seguimiento medio de 12 meses. Esta serie es la primera comunicación nacional de reconstrucción microquirúrgica en pacientes pediátricos traumáticos.

Pterigium colli y su reconstrucción / Pterigium colli and its reconstruction

The Pterigium colli is a cervical malformation included in several syndromes, produces an important stigmatization of patients because of its evident location, implying that a real solution becomes necessary in a 100 percent of the cases. Through history, many reconstructive alternatives have been described; the aim of this paper is to present a review of the most common surgical technics, its results and complications.

El Pterigium colli es una malformación cervical que forma parte de varios síndromes, produce una importante estigmatización de los pacientes portadores dado lo notorio de su ubicación, lo cual hace que su solución sea necesaria casi en el 100 por ciento de los casos. A través de la historia se han descrito varias alternativas reconstructivas, el objetivo de este documento es presentar una revisión de las técnicas más utilizadas, sus resultados y complicaciones.

Fibrosis sistémica nefrogénica: Presentación de un caso y revisión de la literatura / Nephrogenic systemic fibrosis: A case report and review of the literature

La fibrosis sistémica nefrogénica (FSN) es una enfermedad fibrosante de reciente identificación, que afecta exclusivamente a pacientes con insuficiencia renal. Se caracteriza por una fibrosis extensa de los tejidos, especialmente de la piel. Aunque su etiología no es del todo conocida, se ha asociado fuertemente al uso de contrastes de gadolinio en pacientes con insuficiencia renal avanzada. Se describe a continuación un caso de FSN diagnosticado en España.(AU)

Nephrogenic systemic fibrosis (NSF) is a rare condition appearing only in patients with severe renal impairment and characterized by widespread tissue fibrosis. Although the pathogenesis of this disorder remains unclear, there is evidence of a strong association between gadolinium-based contrast agents (Ga-CA) exposure and the triggering of this disease. Cellular elements involved in pathogenesis of NSF include bone-marrow-derived collagen producing fibrocytes, myofibroblasts and activated macrophages. We present the case of a caucasian female with advanced renal failure who underwent several times magnetic resonance imaging (MRI) procedures using Ga-CA. The patient developed a progressive fibrosing disorder with bilateral indurated papules on the lower legs, joint contractures and hairlessness, and was diagnosed of NSF based on the histologic findings of skin biopsies. Later in the disease she presented with systemic involvement and fatal evolution.(AU)

Fibrosis sistémica nefrogénica: Presentación de un caso y revisión de la literatura / Nephrogenic systemic fibrosis: A case report and review of the literature

La fibrosis sistémica nefrogénica (FSN) es una enfermedad fibrosante de reciente identificación, que afecta exclusivamente a pacientes con insuficiencia renal. Se caracteriza por una fibrosis extensa de los tejidos, especialmente de la piel. Aunque su etiología no es del todo conocida, se ha asociado fuertemente al uso de contrastes de gadolinio en pacientes con insuficiencia renal avanzada. Se describe a continuación un caso de FSN diagnosticado en España.

Nephrogenic systemic fibrosis (NSF) is a rare condition appearing only in patients with severe renal impairment and characterized by widespread tissue fibrosis. Although the pathogenesis of this disorder remains unclear, there is evidence of a strong association between gadolinium-based contrast agents (Ga-CA) exposure and the triggering of this disease. Cellular elements involved in pathogenesis of NSF include bone-marrow-derived collagen producing fibrocytes, myofibroblasts and activated macrophages. We present the case of a caucasian female with advanced renal failure who underwent several times magnetic resonance imaging (MRI) procedures using Ga-CA. The patient developed a progressive fibrosing disorder with bilateral indurated papules on the lower legs, joint contractures and hairlessness, and was diagnosed of NSF based on the histologic findings of skin biopsies. Later in the disease she presented with systemic involvement and fatal evolution.

Parotiditis crónica recurrente en el niño / Chronic recurrent parotiditis in children

La Parotiditis crónica recurrente (PCR) en niños es una enfermedad de etiología desconocida y evolución autolimitada caracterizada por episodios de aumento de volumen parotídeos dolorosos asociados a sialectacia parotidea no obstructiva. Su estudio y tratamiento no obedece a criterio único. El objetivo del presente trabajo es revisar nuestra experiencia con el uso de mucolíticos como tratamiento sintomático en los periodos agudos de la enfermedad. Pacientes y MÚtodo: Se estudiaron en forma retrospectiva las características clínicas, estudio de imágenes y respuesta clínica al uso de mucolítico (Bromhexina) en 25 pacientes tratados por parotiditis crónica recurrente entre 1993 y 1999, en el policlínico de cirugía del Hospital Roberto del Río. Resultados: La distribución por gÚnero del grupo en estudio fue de 16 hombres y 9 mujeres, con una relación de 1,8:1. El 92 por ciento se tenía entre 4 a 10 años. El aumento de volumen como síntoma estuvo presente en el total de los casos y al momento de la primera consulta todos los pacientes habían presentado por lo menos 1 episodio antes. Hubo respuesta clínica favorable al uso de mucolíticos en el 100 por ciento de los casos, manifestada como disminución del dolor entre 48 y 96 h luego de comenzada la administración del mucolítico. La Parotiditis crónica inespecífica, como todas las enfermedades crónicas con periodos de reagudización ofrece algunas dificultades para su evaluación y tratamiento. El uso de mucolíticos disminuye el periodo sintomático en relación a los descrito en la literatura y puede ser una buena alternativa terapÚutica.

Hipotensión ortostática: una manifestación sugerente de feocromocitoma / Orthostatic hypotension: as an unusual manifestation of pheochromocytoma

Pheochromocytoma, though an uncommon cause of hipertension, can be a lethal condition. Because of this it is mandatory to diagnose it or rule it out in presence of suggestive symptoms. Typical symptoms are palpitations, sweating, severe headaches and hypertension. However, there are other suggestive symptoms of this dangerous endocrine entity, one of which is the orthostatic hypotension. We report the case of a 65 years old female patient with long standing hypertension in whom the pheochromocytoma was suspected after episodes of orthostatic hypotension. Although this manifestation was described almost fifty years ago, its frequency and pathophysiology has not yet been well established and fully elucidated. Moreover, it has meaningful implications in relation to preoperatory management and the timing of surgery (Rev Méd Chile 2003; 131: 1429-33).

Prevalence of diarrheogenic Escherichia coli and rotavirus among children from Botucatu, São Paulo State, Brazil.

In a one-year prospective study carried out to define the role of rotavirus and Escherichia coli in local childhood diarrhea, we determined the prevalence of both agents in 54 diarrheic children attending a health center in Botucatu. Diarrheogenic E. coli (DEC) strains were characterized by O:H serotyping, a search for virulence genetic markers, and assays of adherence to HEp-2 cells. Except for enteroaggregative E. coli (EAEC), no other DEC category was detected in the children's stools. Both EAEC and rotavirus were isolated from 22 of the 54 (41.0%) diarrheic children as single agents or in combination with other enteropathogens. However, when considering the presence of a single agent, EAEC was dominant and isolated from 20.4% of the patients, whereas rotavirus was detected in 14.8%. These results indicate that rotavirus and EAEC play a significant role as agents of childhood diarrhea in the local population.

Prevalence of diarrheogenic Escherichia coli and rotavirus among children from Botucatu, Säo Paulo State, Brazil

In a one-year prospective study carried out to define the role of rotavirus and Escherichia coli in local childhood diarrhea, we determined the prevalence of both agents in 54 diarrheic children attending a health center in Botucatu. Diarrheogenic E. coli (DEC) strains were characterized by O:H serotyping, a search for virulence genetic markers, and assays of adherence to HEp-2 cells. Except for enteroaggregative E. coli (EAEC), no other DEC category was detected in the children's stools. Both EAEC and rotavirus were isolated from 22 of the 54 (41.0 percent) diarrheic children as single agents or in combination with other enteropathogens. However, when considering the presence of a single agent, EAEC was dominant and isolated from 20.4 percent of the patients, whereas rotavirus was detected in 14.8 percent. These results indicate that rotavirus and EAEC play a significant role as agents of childhood diarrhea in the local population

Aislamiento de enterococcus faecium resistente a vancomicina con genotipo vanB en el Hospital Clínico Regional de Concepción / Isolation of vancomycin resistant enterococcus faecium with genotype vanB at the Hospital Clínico Regional de Concepción

La resistencia bacteriana a los agentes antimicrobianos ha aumentado durante las últimas décadas. De particular importancia es la descripción de aislamientos de Enterococcus resistente a vancomicina (EVR), de reciente y progresiva descripción en nuestro país. Comunicamos el aislamiento de dos cepas de E. faecium resistentes a vancomicina de pacientes colonizados por este microorganismo en el Hospital Clínico Regional de Concepción. El estudio feno y genotípico fue positivo para vanB, además ambos aislamientos presentaron similitud genética en un estudio de tipificación molecular por rep-PCR. Interesantemente el aislamiento de estas cepas precedió al aislamiento de EVR según el protocolo ministerial. Esta diferencia puede explicarse por los factores de riesgo que presentaron los pacientes estudiados

Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela.

OBJECTIVE: The purpose of this study was to evaluate the use of sonographically guided directional vacuum-assisted biopsy in the histologic diagnosis of breast lesions. MATERIALS AND METHODS: Eighty-eight lesions in 83 women underwent sonographically guided 11-gauge directional vacuum-assisted breast biopsy during a 26-month period. Biopsies were performed using high-resolution sonography equipment with a 7.5-MHz transducer, obtaining a median of 17 specimens per lesion. Imaging studies, medical records, and histologic findings were reviewed. RESULTS: Median patient age was 48 years (range, 25-78 years). Median lesion size was 1.2 cm (range, 0.4-2.5 cm). Twenty-four (27.3%) of 88 lesions were palpable. The median time required to perform biopsy was 17 min (range, 10-40 min). Complete removal of the lesion seen at sonography occurred in 78 (88.6%) of 88 lesions and was significantly more frequent in lesions measuring 1.5 cm or less than in larger lesions (68/71 = 95.8% vs 10/17 = 58.8%,p < 0.0003). A surgical procedure was spared in 79 (95.2%) of 83 women. In 36 lesions with imaging and clinical follow-up after sonographically guided biopsy with benign findings (range, 4-24 months; median, 11.3 months), we found no evidence of cancer or scarring in the breast. CONCLUSION: In our small series, sonographically guided directional vacuum-assisted biopsy was a fast and accurate method for breast diagnosis. This technique resulted in complete removal of 95.8% of lesions shown at sonography measuring 1.5 cm or less and spared a surgical procedure in 95.2% of women. Further work is necessary to refine indications, evaluate cost-effectiveness, and assess long-term outcome.

[Solitary pelvic kidney and vaginal agenesia]. / Riñón pelviano solitario y agenesia vaginal.

OBJECTIVE: To present a case of solitary pelvic kidney with congenital absence of the vagina. METHODS: A patient with solitary pelvic kidney and vaginal aplasia is described. Patient evaluation included hematological, hormonal, cytogenetic, laparoscopic and imaging studies. RESULTS: Blood, hormone and cytogenetic studies were normal. Laparoscopy showed absence of the uterus and both tubes and ovaries, which was confirmed by pneumopyelography. IVP showed absence of renal shadows and a solitary pelvic kidney. CONCLUSIONS: Congenital absence of the vagina should be suspected in a patient with a pelvic solitary kidney consulting for primary amenorrhea.

[Natural Trypanosoma cruzi infection of Triatominae bugs associated with human habitations in Mexico ]. / Infección natural de chinches Triatominae con Trypanosoma cruzi asociadas a la vivienda humana en México.

OBJECTIVE: To estimate the prevalence of infection with Trypanosoma cruzi in Triatominae species frequently found in and around Mexican dwellings, and to assess the frequency of Triatominae in towns by state. MATERIAL AND METHODS: Between January 1993 and December 1999, 5,399 Triatominae bugs from 14 states of Mexico, were received in the Department of Entomology of the Institute for Epidemiologic Diagnosis and Referral (InDRE), for taxonomic determination and parasitoscopical search of Trypanosoma cruzi. Results obtained between 1993 and 1999 were analyzed globally. RESULTS: From 13 bug species associated with human dwellings, nine were naturally infected with T. cruzi. The highest percentage of infection occurred in Triatoma pallidipennis, T. picturata, Rhodnius prolixus and T. longipennis. Nayarit, Morelos, and Michoacán were the states with the highest percentage of infected bugs. The species T. dimidiata, T. gerstaeckeri, T. longipennis, T. mexicana and T. pallidipennis were first state records and Pastrongylus rufotuberculatus was a first local record. CONCLUSIONS: These findings stress the importance of studying the biology of Triatominae and the need for permanent surveillance, to allow for up-to-date distribution records of Triatominae species in and around human dwellings, those adapting to human dwellings, and frequencies of those naturally infected by T. cruzi.